Propofol

1. See Also
   1. Conscious Sedation
   2. Rapid Sequence Protocol
2. Mechanism
   1. Sedative hypnotic
   2. No Analgesic effect
   3. Drug Abuse potential (especially among anesthesiologists, nurse anesthetists, emergency medicine staff, dentists)
      1. Increases Dopamine levels which may reinforce addiction
      2. Increases Serotonin levels which may be Hallucinogenic
      3. References
         1. Majoewsky (2012) EM:RAP 12(1): 3
3. Dosing: Adults
   1. Deep Sedation (not FDA approved)
      1. Dose 1 mg/kg IV over 20 to 30 seconds
      2. May repeat 0.5 mg/kg IV as needed
   2. Intubation Sedation (not FDA approved)
      1. Dose 2 to 2.5 mg/kg IV over 20 to 30 seconds
   3. VentilatorSedation in ICU
      1. Infusion: 5-50 mcg/kg/min
   4. Anesthesia
      1. Age under 55 years old
         1. Titration: 40 mg IV every 10 seconds until induction achieved
         2. Typical cummulative total dose: 2 to 2.5 mg/kg
         3. Maintenance infusion: 100-200 mcg/kg/min
      2. Age 55 years old or older
         1. Decrease dose from that list above for younger patients
4. Dosing: Children
   1. Deep Sedation (not FDA approved)
      1. Dose 1 mg/kg IV (up to 40 mg maximum) over 20 to 30 seconds
      2. May repeat 0.5 mg/kg IV (up to 20 mg maximum) as needed
      3. Avoid for prolonged ICU use
   2. Anesthesia (age 3 years and older)
      1. Typical cummulative total dose: 2.5 to 3.5 mg/kg over 20-30 seconds
      2. Maintenance infusion: 125-300 mcg/kg/min
5. Contraindications
   1. Soy allergy
   2. Egg allergy
6. Adverse Effects
   1. Propofol Infusion Syndrome
   2. Cardiopulmonary adverse effects (reduced by administering with lower dose and slower titration)
      1. Respiratory depression
      2. Hypotension and myocardial depression
   3. Overdose
      1. No antidote
      2. Manage with ABC Management and supportive care